First Name*
Last Name*
Your Email* (This email will be provided to the members of your group)
How Did You Hear About Urban Islands Project?* FriendBetter PastorsUrban Islands WebsiteExponential ConferenceOther Conference or Event If "Other Conference or Event" please provide details:
Current/Most Recent Area of Ministry* (Although your ministry may overlap with several areas, feel free to select the one with which you resonate most) Lead PastorExec/Asso PastorYouthKids/FamilyCollege MinistryMissions (US or World)AcademiaWorship/MusicOther
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Share as much information as you know, it is ok to be in flux with some of this information.
In What City Will You Be Planting? (Leave blank if unknown)
Are You Living In the Neighborhood In Which You Will Be Planting? YesIn ProcessNot Currently, but Intend toNo, and do not intend toOther
If "Other" please provide details:
Tell Us About The Area You Will Be Planting:
What is Your Connection with this Area?
Do You Have a Sending Organization, If so, who?
What is your current strategy for financial support?
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To help us match you up with a group please tell us a bit about yourself
Gender* MaleFemalen/a
Relationship Status* MarriedSingle
Spouse's Name
Spouse's Email
For those who are married, we expect and encourage spouses to participate and attend the retreat. It is extremely important that both spouses participate in the retreat, but for the video chats and weekly interactions it is not as necessary. Unfortunately, children are not able to attend the retreat. My spouse and I are intending to co-lead the new church.
Age*
Years in Ministry*
Church Starting EXPERIENCE* (Check all that apply) No prior experience in starting a church.Helped start a church.Have been the primary leader of a new church start-up.Have been the primary leader of multiple church start-ups.
Church Starting EDUCATION* (Check all that apply) I am completely new to the concept of starting a new church.I have read some books and articles about starting a new church.I have attended a church planting focused conference or conferences.I have taken some college or graduate level courses on church starting.I have a formal degree in church starting/planting.
Have you taken a church planter assessment?
If so, please upload results here or email to convo@urbanislandsproject.org
If not, you can take one by following this link: (Please note: If you are approved for inclusion in the cluster, the cost of the assessment will be included in your registration fee. If you are not approved to be in the cluster, you will be billed $150 via email to cover the cost of the assessment. By using the code URBAN2019, you are agreeing to be responsible for the cost of the assessment.) https://questionnaire.cmnassessment.com
Use code: URBAN2019
What types of things do you do for fun?
Tell us about a defining moment in your life:
Share some long term personal goals:
Is there someone with whom you would like to be placed in a group? If so, please give us their name:
What else would you like us to know:
If you are accepted into the group, you will receive an email with payment instructions. You will have 48 hours to complete your initial payment.
Which payment option do you intend to utilize?* This can be changed within the first 30 days —Please choose an option—$200 per month$2,200 discounted single paymentDon't know/not sure
Who will be making the payment(s)?* —Please choose an option—SelfFamily or FriendSending ChurchSending Organization
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(This will be shared with the other members of your group)
Phone Number* Texting Okay
What social media do you use regularly? FacebookTwitterInstagramLinkedInOther
Please Provide A Link (or handle) To Your Social media Profile(s):
Affiliation * —Please choose an option—NoneAdvent Christian General ConferenceAnglican Mission in AmericaAssemblies of GodBrethren Church, TheBrethren in Christ ChurchChristian and Missionary AllianceChristian Reformed Church in North AmericaChristian UnionChurch of God (Cleveland, Tennessee)Church of the NazareneConservative Congregational Christian ConferenceConverge WorldwideECO: A Covenant Order of Evangelical PresbyteriansElim FellowshipEvangelical Assembly of Presbyterian ChurchesEvangelical Church, TheEvangelical Congregational ChurchEvangelical Free Church of AmericaEvangelical Friends Church InternationalEvangelical Presbyterian ChurchEvery Nation ChurchesFellowship of Evangelical Bible ChurchesFellowship of Evangelical ChurchesFoursquare Church, TheFree Methodist Church USAGrace Communion InternationalGreat Commission ChurchesInternational Pentecostal Church of ChristInternational Pentecostal Holiness ChurchMissionary Church, Inc.North American Baptist ConferenceOpen Bible ChurchesPresbyterian Church in AmericaPrimitive Methodist Church USASalvation Army, TheTransformation MinistriesUnited Brethren in ChristU.S. Conference of the Mennonite Brethren ChurchesVineyard USAWesleyan Church, TheOther
